The dilemma of protein delivery in the intensive care unit

Veldsman, Lizl; Richards, Guy A.; Blaauw, R.

doi:10.1016/j.nut.2016.02.010

Cited by 4 publications

(4 citation statements)

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“…However, overall protein intake is low, and the caloric and protein intake are insufficient to meet the higher nutritional needs of a surgical patient. Carbohydrates remain a predominant energy source in Rwanda, with low levels of protein intake, similar to other countries in sub-Saharan Africa [14,[17][18][19]. There are opportunities for improving nutrition intake by increasing the amount of protein consumed in each meal.…”

Section: Discussionmentioning

confidence: 99%

Nutritional intake in acute care surgery patients in Kigali, Rwanda- A single institution descriptive analysis

Jones¹,

Niyongombwa²,

Karenzi³

et al. 2022

rmj

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INTRODUCTION: Nutrition is essential for health and healing, especially in the perioperative period. However, little is known about the nutritional intake of hospitalized patients in low and middle-income countries.This paper aimed to characterize the composition and quantity of food in acute care surgery patients at a tertiary referral hospital in Rwanda. METHODS: Acute care surgery patients were queried about nutritional intake during hospitalization from May 21, 2018, to June 3, 2018, for 100 patient days. Calorie and protein intake were estimated and compared to standards for an average Rwandan adult.RESULTS: Median daily calorie intake was 1472 kcal/day (Interquartile range (IQR): 662, 2116). The median daily protein intake was 45.99 g (IQR: 24.38, 70.22). Assuming a calorie need of 25 kcal/kg/day and a protein need of 1g/kg/day, this is 98.1% of the estimated daily calorie needs and 76.7% of estimated daily protein needs. Estimating higher energy needs for a surgical patient, the daily intake is 70.0-81.9% of calorie needs and 51.1-63.9% of protein needs. CONCLUSION: Overall, the calorie and protein intake for the average Rwandan acute care surgery patient were low compared to the needs of a 60 kg surgical patient. More education and accessibility to high-quality foods are needed to ensure adequate nutrition in the postoperative period to optimize clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Nutritional intake in acute care surgery patients in Kigali, Rwanda- A single institution descriptive analysis

Jones¹,

Niyongombwa²,

Karenzi³

et al. 2022

rmj

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“…Veldsman et al [9] reported a median time to EN initiation of 11 hours, while Lofgren et al [10] reported that 63.3% of patients were fed within 48 hours of ICU admission. In this study, 80% of patients received EN by D7, which is in contrast with the 94% of patients reported by Lofgren et al [10] There are key differences in the patient cohorts represented in these studies, as Veldsman et al [9] reported on a predominantly medical population, while Lofgren et al [10] evaluated trauma patients. These differences were associated with patient demographic and outcome differences, including differences in median age and, lower rates of sepsis, organ support and ICU mortality.…”

Section: Discussionmentioning

confidence: 99%

“…[6] Only two SA studies have been conducted to date. [9,10] Of these, one conducted in a multidisciplinary ICU reported a median time to initiation of feeds of 11 hours, with 27% of patients failing to meet at least 90% of their energy target. [9] This study presents findings that do not correlate with large international studies and did not explore barriers to nutritional therapy.…”

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confidence: 99%

“…[9,10] Of these, one conducted in a multidisciplinary ICU reported a median time to initiation of feeds of 11 hours, with 27% of patients failing to meet at least 90% of their energy target. [9] This study presents findings that do not correlate with large international studies and did not explore barriers to nutritional therapy. The second study was conducted in a trauma ICU and reported that only 63% of patients had initiated EN within 48 hours, with only 63% achieving nutritional goals, from initiation of enteral nutrition, in less than 96 hours.…”

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confidence: 99%

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An evaluation of feeding practices and determination of barriers to providing nutritional support in a multidisciplinary South African intensive care unit

Elmezoughi

Vasconcellos

2020

S Afr J Crit Care

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Adequate nutritional support may improve morbidity and mortality, and long-term functional outcome in critically ill patients. However, there are many potential barriers to the adequate provision of nutrition to critically ill patients. It is unclear whether critically ill patients in South Africa (SA) receive adequate nutrition, and which barriers (if any) may contribute to suboptimal nutrition. Knowledge of the preceding may lead to interventions to improve the nutritional support of critically ill patients in SA. Critical illness is a catabolic state associated with rapid loss of muscle mass and frequent complications including poor wound healing and infectious complications. [1,2] Critically ill patients are nutritionally 'at risk'. [3] Adequate nutritional support, in particular early enteral nutrition (EN), is associated with a reduction in morbidity, reduced intensive care unit (ICU) length of stay (LOS), improved long-term functional outcomes and, possibly, reduced mortality. [2] Current practice guidelines agree that EN should be initiated within 48 hours after ICU admission and that early EN is preferred over parenteral nutrition (PN). [1,2] While nutritional goals and the optimal timeframe to achieve these goals are controversial, the most recent European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend that full EN goal feeds are to be prescribed within 3-7 days, to avoid the risk of early overfeeding. [1] The timing of initiation of PN is also controversial. Initiation of PN may be delayed up to 7 days in adequately nourished patients. [1] In patients at high nutritional risk PN should be initiated as soon as possible if EN is not feasible. [2] As with EN, full PN goal rates should only be prescribed within 3-7 days to prevent early overfeeding. Supplemental PN may be initiated after 7 days if >60% of nutritional requirements have not been achieved. [2] Despite an increasing awareness of the benefits of adequate nutritional support, nutritional goals are often not met. [1,3] De Jonghe et al. [4] reported that only 71% of required calories were delivered in their cohort of medical ICU patients. Delays in initiation of enteral feeding are common, with studies showing that only 33.3% of patients had feeds initiated within 48 hours of ICU admission and only 9% of patients

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Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study): Does nutrition really affect ICU mortality?

Goixart¹,

Grau-Carmona²,

Trujillano³

et al. 2022

Clinical Nutrition ESPEN

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Background & aims: The importance of artificial nutritional therapy is underrecognized, typically being considered an adjunctive rather than a primary therapy. We aimed to evaluate the influence of nutritional therapy on mortality in critically ill patients. Methods: This multicenter prospective observational study included adult patients needing artificial nutritional therapy for >48 h if they stayed in one of 38 participating intensive care units for !72 h between April and July 2018. Demographic data, comorbidities, diagnoses, nutritional status and therapy

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The dilemma of protein delivery in the intensive care unit

Cited by 4 publications

References 22 publications

Nutritional intake in acute care surgery patients in Kigali, Rwanda- A single institution descriptive analysis

Nutritional intake in acute care surgery patients in Kigali, Rwanda- A single institution descriptive analysis

An evaluation of feeding practices and determination of barriers to providing nutritional support in a multidisciplinary South African intensive care unit

Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study): Does nutrition really affect ICU mortality?

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